Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients

Abstract Background Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients. Results This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV. Conclusion Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.

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Role of Serum Ascites Albumin Gradient (SAAG) and Portal Vein Congestion Index as Non-‎Invasive Methods for Prediction of Esophageal Varices in Cirrhotic Patients ‎

Afro-Egyptian Journal of Infectious and Endemic Diseases ◽

10.21608/aeji.2021.81275.1151 ◽

2021 ◽

Vol 0 (0) ◽

pp. 270-283

Author(s):

Gamal Eldeeb ◽

Shimaa Hassanein ◽

Ibrahim Abd-Elmawla ◽

Naglaa Elabd

Keyword(s):

Portal Vein ◽

Esophageal Varices ◽

Non Invasive ◽

Cirrhotic Patients ◽

Congestion Index

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Evaluation of portal pressure by doppler ultrasound in patients with cirrhosis before and after simvastatin administration – a randomized controlled trial

F1000Research ◽

10.12688/f1000research.13915.1 ◽

2018 ◽

Vol 7 ◽

pp. 256 ◽

Cited By ~ 1

Author(s):

Nadia Elwan ◽

Raafat Salah ◽

Manal Hamisa ◽

Ebtsam Shady ◽

Nehad Hawash ◽

...

Keyword(s):

Blood Flow ◽

Portal Hypertension ◽

Portal Vein ◽

Hepatic Artery ◽

Doppler Ultrasound ◽

Resistance Index ◽

Control Group ◽

Randomized Controlled ◽

Group I ◽

Before And After

Background: Portal hypertension is one of the most frequent complications of cirrhosis. β-adrenergic blockers, with or without organic nitrates, are currently used as hypotensive agents. Statins such as simvastatin seem to be safe for patients with chronic liver diseases and exert multiple pleiotropic actions. This study aimed to assess PTH using Doppler ultrasound in patients with cirrhosis before and after simvastatin administration. Methods: This randomized controlled clinical trial was conducted on 40 patients with cirrhosis who were randomized into 2 groups: group I included 20 patients with cirrhosis who were administered 20 mg of simvastatin daily for 2 weeks and then 40 mg daily for another 2 weeks, and group II included 20 patients with cirrhosis who did not receive simvastatin as a control group. All patients underwent full clinical examination, laboratory investigations, and abdominal Doppler ultrasound at baseline and after 30 days to evaluate portal vein diameter, blood flow volume, direction and velocity of portal vein blood flow, hepatic artery resistance and pulsatility indices, splenic artery resistance index, portal hypertension index (PHI), liver vascular index, and modified liver vascular index (MLVI). Results: There was a highly significant decrease in the hepatic artery resistance index in group I, from 0.785 ± 0.088 to 0.717 ± 0.086 (P < 0.001). There was a significant decrease in the PHI in group I , from 3.915 ± 0.973 m/sec to 3.605 ± 1.168 m/sec (P = 0.024). Additionally, there was a significant increase in the MLVI in group I from 11.540 ± 3.266 cm/sec to 13.305 ± 3.222 cm/sec, an increase of 15.3% from baseline (P = 0.009). No significant adverse effects were detected. Conclusions: Simvastatin is safe and effective in lowering portal hypertension. [ClinicalTrials.gov Identifier: NCT02994485]

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The role of ultrasonography in the evaluation of portal hemodynamics in healthy adults and pathologic conditions

ARS Medica Tomitana ◽

10.1515/arsm-2016-0022 ◽

2016 ◽

Vol 22 (2) ◽

pp. 128-134 ◽

Cited By ~ 3

Author(s):

C. Anda Achim ◽

P. Bordei ◽

E. Dumitru

Keyword(s):

Blood Flow ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Portal Vein ◽

Esophageal Varices ◽

Healthy Subjects ◽

Portal Blood Flow ◽

Control Group ◽

Portal Hemodynamics ◽

Cirrhotic Patients

AbstractIntroduction: Portal hypertension results from increased resistance to the portal blood flow. The ultrasound represents a noninvasive tool for assessing the structural and hemodynamic abnormalities in this condition.Objectives: The assessment of the hemodynamic blood flow of the liver and spleen by using Doppler ultrasound in patients with portal hypertension compared with healthy subjects and to identify correlations with the severity of liver cirrhosis and esophageal varices.Materials and Method: This study included 50 patients with liver cirrhosis and 20 healthy subjects as controls. Different correlations were carried out between hemodynamic variables obtained from the Doppler examination and the severity of cirrhosis as assessed by the Child score and the degree of esophageal varices at endoscopy.Results: The portal vein diameter was larger in cirrhotic patients compared with the control group. The mean portal vein velocity and the blood flow were significantly lower in advanced forms of liver cirrhosis. The portal vein congestion index, the pulsatility and resistivity indexes of the hepatic artery were significantly increased in patients with CHILD B and C cirrhosis compared with the control group and patients in CHILD class A. There were no statistically significant differences between the pulsatility and resistivity indexes of the splenic artery in patients with cirrhosis. The liver vascular index was significantly lower in patients with advanced cirrhosis.Conclusions: The ultrasound is a valuable noninvasive tool for cirrhotic patients with portal hypertension. However, it is not sufficiently accurate in differentiating between different classes of cirrhosis or degrees of esophageal varices.

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Study of Portal Vein Diameter and Spleen Size by Ultrasonography and Their Association with Gastro-esophageal Varices

Nepalese Journal of Radiology ◽

10.3126/njr.v4i2.18482 ◽

2017 ◽

Vol 4 (2) ◽

pp. 6-14

Author(s):

Subash Bhattarai ◽

M Gyawali ◽

KR Dewan ◽

G Shrestha ◽

BS Patowary ◽

...

Keyword(s):

Portal Vein ◽

Esophageal Varices ◽

Spleen Size ◽

Cutoff Value ◽

Non Invasive ◽

Vein Diameter ◽

Cirrhotic Patients ◽

Positive Correlations ◽

Cirrhosis Of Liver

Introduction: Upper Gastro-intestinal endoscopy is considered the best screening tool for varices in cirrhotic patients. It is still an expensive, invasive tool, has poor compliance and not routinely available in every hospitals in Nepal. This study was undertaken to establish the role of portal vein diameter and spleen size by ultrasonography in predicting gastro-esophageal varices.Method: One hundred and fifty patients with clinical features, laboratory and sonological findings suggestive of cirrhosis of liver and endoscopic evidence of portal hypertension were included in the study. Ultrasonography assessments of portal vein diameter and spleen size alongside endoscopy for detection of varices were done.Result: Average portal vein diameter of patients without gastro-esophageal varices was 10.800 ± 1.1402 mm, while it was 13.731 ± 1.061mm in patients with varices(p<0.001). Average spleen size of patients without varices was 12.67 ± 2.35 cm and with varices was 15.367 ± 1.210 cm (p < 0.001). There was 92.72 % sensitivity and 90 % specificity for prediction for presence of esophageal varices when the cutoff value for portal vein diameter was 12.25 mm. There was 94.5 % sensitivity and 75 % specificity for prediction for presence of esophageal varices when the cutoff value for spleen size was 13.9 cm.Conclusion: Ultrasonography of portal vein diameter and spleen size is a reliable non invasive tool in predicting the presence of gastro-esophageal varices in patients with liver cirrhosis. With increase in portal vein diameter and spleen size, risk of formation of gastro-esophageal varices also increases and positive correlations exist between them. Nepalese Journal of Radiology, VOL 4 No. 2 ISSUE 7 July-December, 2014: 6-14

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Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00344-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Ahmed Abdelrahman Mohamed Baz ◽

Rana Magdy Mohamed ◽

Khaled Helmy El-kaffas

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Portal Vein ◽

Hepatic Artery ◽

Meld Score ◽

Hepatic Decompensation ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

Us Findings ◽

End Stage

Abstract Background Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly. Results By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV). There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266). Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate. Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated. Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity. Conclusion Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.

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The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

BMC Gastroenterology ◽

10.1186/s12876-019-1123-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Daniel W. Gunda ◽

Semvua B. Kilonzo ◽

Zakhia Mamballah ◽

Paulina M. Manyiri ◽

David C. Majinge ◽

...

Keyword(s):

Liver Cirrhosis ◽

Esophageal Varices ◽

Clinical Laboratory ◽

Cross Sectional Study ◽

Endoscopic Examination ◽

Clinical Predictors ◽

Endoscopic Screening ◽

Cross Sectional ◽

Northwestern Tanzania ◽

Cirrhotic Patients

Abstract Background Bleeding esophageal varices is a deadly complication of liver cirrhosis. Guidelines recommend an early diagnosis of esophageal varices before incident bleeding by screening all patients diagnosed with liver cirrhosis. Though it has been reported elsewhere that the presence of esophageal varices varies widely among cirrhotic patients this has not been assessed in Tanzania since endoscopy is not readily available for routine use in our setting. This study was designed to determine the prevalence of esophageal varices and assess the utility of clinical parameters in predicting the presence of varices among cirrhotic patients in northwestern Tanzania. Methods A cross-sectional analysis of adult patients with liver cirrhosis was done at Bugando Medical Centre. Demographic, clinical, laboratory and endoscopic data were collected and analyzed using STATA 13. The presence of esophageal varices was detected using endoscopic examination and associated factors were assessed by logistic regression. The predictive value of clinical predictors was also assessed by calculating sensitivity and specificity. Results A total of 223 patients were enrolled, where 88 (39.5%; 95%CI: 33.0–45.9) had esophageal varices. The varices were independently associated with increased age (OR: 1.02; 95%CI: 1.0–1.04; p = 0.030); increased splenic diameter (OR:1.3; 95%CI:1.2–1.5; p < 0.001), increased portal vein diameter (OR:1.2; 95%CI: 1.07–1.4; p = 0.003), having ascites (OR: 3.0; 95%CI: 1.01–8.7; p = 0.046), and advanced liver disease (OR: 2.9; 95%CI: 1.3–6.7; p = 0.008). PSDR least performed in predicting varices, (AUC: 0.382; 95%CI: 0.304–0.459; cutoff: < 640; Sensitivity: 58.0%; 95%CI: 46.9–68.4; specificity: 57.0%; 95%CI: 48.2–65.5). SPD had better prediction; (AUC: 0.713; 95%CI: 0.646–0.781; cut off: > 15.2 cm; sensitivity: 65.9%; (95% CI: 55–75.7 and specificity:65.2%; 95%CI: 56.5–73.2), followed by PVD, (AUC: 0.6392; 95%CI: 0.566–0.712;cutoff: > 1.45 cm; sensitivity: 62.5%; 95CI: 51.5–72.6; specificity: 61.5%; 95%CI: 52.7–69.7). Conclusion Esophageal varices were prevalent among cirrhotic patients, most of which were at risk of bleeding. The non-invasive prediction of varices was not strong enough to replace endoscopic diagnosis. However, the predictors in this study can potentially assist in the selection of patients at high risk of having varices and prioritize them for endoscopic screening and appropriate management.

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Thyroid and Hepatic Haemodynamic Alterations among Egyptian Children with Liver Cirrhosis

ISRN Gastroenterology ◽

10.5402/2012/595734 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Zeinab A. El-Kabbany ◽

Rasha T. Hamza ◽

Ahmed S. Abd El Hakim ◽

Lamis M. Tawfik

Keyword(s):

Hepatic Artery ◽

Pulsatility Index ◽

Standard Deviation Score ◽

Resistance Index ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Inferior Thyroid Artery ◽

Egyptian Children ◽

Cirrhotic Patients ◽

Arterial Haemodynamics

Background. Alterations in thyroid hormones regulation and metabolism are frequently observed in patients with cirrhosis. Aims. To assess alterations in thyroid volume (TV), haemodynamics, and hormones in patients with cirrhosis and their relation to hepatic arterial haemodynamics, and disease severity. Methods. Forty cirrhotic patients were compared to 30 healthy subjects regarding TV, free triiodiothyronine (fT3), free tetraiodothyronine (fT4), thyroid stimulating hormone (TSH), and pulsatility and resistance indices in the inferior thyroid and hepatic arteries. Results. TV (P=0.042), thyroid volume standard deviation score (TVSDS, P=0.001), Inferior Thyroid Artery Pulsatility Index (ITAPI, P=0.001), Inferior Thyroid Artery Resistance Index (ITARI, P=0.041), Hepatic Artery Pulsatility Index (HAPI, P=0.029) and Hepatic Artery Resistance Index (HARI, P=0.035) were higher among cases being highest in Child-C patients. FT3 was lower in patients than controls (P=0.001) and correlated negatively with ITAPI (r=−0.71, P=0.021) and ITARI (r=−0.79, P=0.011). ITAPI and ITARI correlated directly with HAPI and HARI (r=0.62, P=0.03, and r=0.42, P=0.04, resp.). Conclusions. Thyroid is involved in the haemodynamic alterations of cirrhosis. Routine study of thyroid by Doppler and assessment of thyroid functions should be performed in patients with cirrhosis to offer proper treatment if needed.

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